The Journey to EHR Optimization

Second in a two-part series from ACCC’s Optimizing Electronic Health Records project. Read part one.

By Joseph Kim, MD, MPH, MBA

While the vast majority of oncology clinicians use an Electronic Health Record (EHR) today, many continue to struggle with poor usability and increased workloads. Recognizing the needs in the community, the ACCC Optimizing Electronic Health Records (EHRs) education initiative aims to identify practical solutions and effective practices to help cancer programs navigate their ongoing journey with EHRs.

ACCC convened two focus groups for this project bringing together a diverse group of stakeholders to talk frankly about how their cancer programs are overcoming some of the common EHR challenges that hinder provider efficacy.  Four key themes emerged during these conversations, read on.

Coordination of EHRs Across Multiple Locations
Given that some cancer programs span multiple locations that offer different services, it remains critical for all the sites to share patient information effectively. However, even when the sites are all using the same EHR, flawless interoperability is not guaranteed since some hospitals may be running different versions of the same system.  As a result, clinicians who work at multiple locations may need to get accustomed to different screen layouts when they log in, or they may have access to different functionalities based on the customizations that exist at each local site. Moreover, the use of certain add-on modules (e.g., Epic Beacon module for medical oncology) may not be consistent across the health system. Ample opportunities remain to standardize the digital workflow across health systems so that clinicians can work more efficiently.

Another common barrier in the community is the lack of interoperability across the systems used by medical oncology, radiation oncology, pathology, radiology, and the hospital. While some health systems are consolidating to a single EHR system across all those departments and services, many still run into challenges with read-only access versus the need to log in to different computers to access patient records. While establishing local interoperability within the same health system remains an ongoing journey, some regions are also actively leveraging solutions offered by the Carequality Interoperability Framework or the CommonWell Health Alliance to achieve interoperability more rapidly.

Data and Reporting
When clinicians switch to a new EHR system, data migration is one of the biggest time-consuming tasks because of the complexity of mapping all the structured data fields from one system to the next. Cancer programs with access to a dedicated informatics specialist can make customizations and run reports with greater ease. Since oncology is changing at a faster pace than any other medical specialty, cancer programs with access to the necessary IT resources are having an easier time offering new therapies and monitoring patients effectively.

While the cancer registry is usually its own separate system, registrars may provide valuable feedback about data fields and automated reports. Cancer programs participating in programs like the ASCO Quality Oncology Practice Initiative (QOPI) or the CMS Oncology Care Model (OCM) have made considerable investments to generate ongoing reports from their EHRs, so other cancer programs may learn from those experiences and adopt similar approaches within their own institutions.

Building Order Sets
By now, most cancer programs have an established process for creating new electronic order sets and treatment plans for new drugs and therapies. They may have a core multidisciplinary team that meets to create and test new treatment protocols. An oncology pharmacist is an essential member of that team, providing guidance around drug dosing and safety alert parameters. Nurses can also provide important input regarding clinical documentation around safety monitoring. Since order sets for oral oncolytic agents need to be linked between the medical oncology EHR and the pharmacy systems, it remains critical to map how orders are transmitted to different specialty pharmacies that dispense those medications. In some cases where those systems are not integrated, redundant workarounds may be required for the e-prescribing of oral agents.

Superusers
Superusers may either be formally designated or informally recognized as tech-savvy clinicians who are willing to play a greater role to help their colleagues and peers use EHRs more effectively. In some cases, superusers may carry over from a recent implementation of a new system. It’s important for cancer programs to maintain and foster a group of superusers who can lead the development of new order sets, help to train new users, and provide input on new releases or customizations to the system. Some cancer programs invest in their superusers by sending them to annual corporate training events so that they can also learn how other health systems are tackling common problems and issues. Be sure to give recognition to the superusers because some may take on more formal roles such as Director of Informatics or Medical information Officer.

Look for more insights from the ACCC Optimizing Electronic Health Records initiative in the coming months.


Guest blogger Joseph Kim, MD, MPH, MBA, is serving as a consultant for the ACCC Optimizing Electronic Health Records (EHRs) initiative.  Dr. Kim is President of Xaf Solutions.

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